Download CORONARY ANGIO CARDIAC CATH & Ablation Procedures

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CORONARY ANGIO
CARDIAC CATH
& Ablation Procedures
Lecture # 3 A
Cardiac Anatomy & Circulation
& Pathology Review # 3B
RT 255 (rev 2010)
Dawn Charman, M.Ed,R.T
Reference:
Frank. Merrill's Atlas of Radiographic Positioning and Procedures, 11th Ed. Mosby
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What is cardiac cath?
• Procedure which involves placement of a
catheter into RT or LT side of heart.
• Invasive
• Coronary angiography is often included
together with cardiac cath
• Diagnostic procedure and/or
• a therapeutic procedure
• Adults & Children
Check out procedure Video:
http://www.youtube.com/watch?v=kY5gKdFWT3k&feature=related
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Cardiac Catheterization
also known as a heart cath or
coronary angiogram
• This procedures provides the
doctor with a "road map" of the
arteries in the heart
• To find any areas of blockage in
the arteries that supply the heart
with blood.
• May also look at the valves,
chambers & heart muscle
• Can help in making decisions
about the treatment of heart
disease.
• It is a usually performed by a
cardiologist with assistance by
RT,(CIT), nursing & support staff*
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Who performs the procedure?
• The Interventional
Radiologist /
Cardiologist
• who specializes in
the Angioplasty
procedure.
• CIT Technologist
• Nursing
• Other support staff
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Cardiac cath requires special equipment:
1. Angio supplies & equipment
2. Fluoro Imaging (w/ Cine – Digital)
3. & Ancillary equipment *
Type of catheter used will
be dependant on the type
Of Procedure performed
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Done in a “Cath Lab”
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•
•
•
•
Cath lab includes
a special table,
x-ray tube &monitor,
supplies (catheter,
guidewire)
• automatic injector
pressure
• Cardiac monitors
• Vitals monitors
B/P , pulse ox,
Improvements in digital storage & resolution has largely replaced cine
Study can be stored on CD-R or DVD’s for review
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Cardiac catheterization
• The oxygen concentration can be
measured across the valves and
walls (septa) of the heart
• Pressures within each chamber of
the heart and across the valves can
be measured.
• The technique can even be
performed in small, newborn infants.
• The catheter also serves the
purpose of monitoring blood
pressures in these different
locations inside the heart.
• The angiogram procedure takes
several hours, depending on the
complexity of the procedure.
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Basic info about procedure
 IV sites in either arm, groin, or neck.
 Flexible catheter inserted to IV through the blood vessel.
 Then, cathether is threaded thorough the blood vessel to
the heart.
 Pressure measured at this point.
 Iodinated contrast injected through catheter once it
reaches the heart.
 Fluoroscopy guides the
cardiologist
with the catheter location.
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Normal Rt & Lt Coronary Arteries
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What Method is this?
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Catherization: Selinger Technique
*
*Modified Seldinger only punctures one side of vessel – this
Percutaneous method can be used for arteries or veins - describes the
method of catheter introduction that is not a direct stick
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Seldinger Technique
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When is it used in
Cardiac Cath?
• used to inject a large amount
(25 to 50 mL) of contrast
material into either the right
or left ventricle the aortic root,
or the pulmonary vessels.
• Because the coronary arteries
are of small caliber and of low
flow rate, administration of
contrast medium into these
structures generally does not
require a high-pressure
injector.
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CARDIAC CATHETERS
•
•
May be inserted in an artery or vein
information is collected on the valves, chambers,
and arteries, as well as the structure and function
of the heart
A cardiac cath can show a cardiologist the precise
location of a blockage or defect
•
• The advantages of
catheterization are as follows:
1. The risk of extravasation is
reduced.
2. Most body parts can be
reached for selective injection.
3. The patient can be positioned
as needed.
4. The catheter can be safely left
in the body while radiographs
are being examined.
Cardiac cath video: http://www.youtube.com/watch?v=yzxSrLa1d0g
A:Judkins RT
B:Judkins LT C:
Pigtail
• Catheter can be introduced
through femoral, brachial or carotid
artery to the knob of the aorta for
coronary arteries
• It may be advanced to the left heart
to look at the LT ventricle
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•
Seldinger Tech is a percutaneous method for the femoral
approach
•
Radial, Subclavian & jugular may also be
used depending on Physician choice and
Pt condition
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Guidewires & Needles
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•
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Otherwise known as:
• Balloon Angioplasty
• Angioplasty
• PTCA
• Balloon Angioplasty is a technique used to dilate an area
of arterial blockage with the help of a balloon catheter.
• It is a way of opening a blocked blood vessel.
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Balloon Angioplasty
• A small area of the
groin or arm is shaved
and cleaned where the
catheter is inserted.
• Medication is used to
anesthetize the area so
a small incision can be
made where the
catheter will be
inserted.
• A catheter with a
deflated balloon on the
tip is inserted through
the artery in the groin
or arm.
• X-ray is used to guide
the catheter up into the
heart.
One Possible Complication:
•Plaque material or blood
clots dislodging and
floating downstream,
leading past the treated
area
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Balloon angioplasty and a stent are used to open up
the stenotic left brachiocephalic vein. Excellent
blood flow was restored in subsequent images.
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Equipment Used During a Procedure:
• Balloon Catheter
• Metal mesh stent
• Pump for balloon
• Usually a metal stent is
placed in the opened artery
to make sure restenosis
does not reoccur
• Following the procedure,
the balloon is deflated and
additional x-rays are taken
to determine how much
blood flow has increased.
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Prevention of
Restenosis
•
•
•
•
•
Lifestyle Change
Healthy diet
adequate exercise
No Smoking
Medicine coated
stents
Although Balloon Angioplasty is a
valuable tool it is not a cure for
Artherosclerosis.
It is only a treatment,
Patients should try to lead a healthy
life which will be the best treatment for
their arteries.
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Coronary Artery Bypass Graft Surgery
• is a surgical procedure to treat severe coronary
artery disease (heart disease).
• Part of a vein or artery (called a graft) from
another part of the body is used to bypass a
blockage in one or more of the coronary arteries.
• The type of graft used,
• a vein* from the leg,
• or an artery from the chest,
• depends on the number
• and location of the blockage.
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Stent Placement
• http://images.google.com/imgres?imgurl=http://www.nhlbi.nih.gov/he
alth/dci/images/stent_restenosis.gif&imgrefurl=http://www.nhlbi.nih.g
ov/health/dci/Diseases/stents/stents_all.html&usg=__xDlbsaX9JhuY
bpVojLcz19aprI=&h=513&w=450&sz=59&hl=en&start=20&tbnid=vWwqaGRNW7MM:&tbnh=131&tbnw=115&prev=/images%3Fq%3Dabdominal%2Bst
ents%26gbv%3D2%26hl%3Den
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AAA
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A stent graft or endograft used to repair aneurysm in the aorta and iliac region.
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CARDIAC
ABLATION
Cardiac Ablation
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RF ABLATION
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In cardiac ablation, a form of energy renders a small
section of damaged tissue inactive. This puts an end
to arrhythmias that originated at the problematic site
•
Most often, cardiac ablation is used to
treat rapid heartbeats that begin in the
upper chambers, or atria, of the heart.
As a group, these are know as
supraventricular tachycardias, or
SVTs. Types of SVTs are:
INDICATIONS
• Atrial Fibrillation
• Atrial Flutter
• AV Nodal Reentrant
Tachycardia
• AV Reentrant
Tachycardia
• Atrial Tachycardia
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Cardiac Ablation
• Minimally invasive treatment for arrhythmias
• Live fluoroscopy and angiography techniques
are used along with special electro physiologic
equipment and catheters
• Performed by a doctor specializing in the hearts
electrical system
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•
•
•
•
Pulse
ECG
Chest pain
Nausea
Syncope
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• Catheter positions for routine
electrophysiologic study.
• Multipolar catheters
• are positioned in the
• high right atrium near
• the sinus node,
• in the area of the
• atrioventricular apex,
• and in the coronary
• sinus.
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Your Hearts
Electrical System
• Sinoatrial node– “Natural Pacemaker”
– Upper Right Atrium
– Produces electrical signal 60-100 times a min
• Atrioventricular node– The bridge that connects Atriums to Ventricles
– Special cells allow electrical signals to pass
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CINE
• HIGHEST IN RADIATION DOSE
• TO THE PATIENT / TECHNOLOGIST
• 1 MR/FRAME X 60 FRAMES/SEC FOR 30
MINUTES = ?
• HEAT LOADS?????
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1 MR/FRAME X 60 FRAMES/SEC FOR
30 MINUTES =
• 1 X 60 = 60 mR/sec
• 60 mR/sec x 60 sec = 3600mR/min
• 3600mR/min x 30 min =
• 108000 mr OR 10.8 R
CINE DOSE
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Imaging Considerations
•
Magnetic resonance imaging (MRI)
– Recently gained in popularity for use in cardiac studies
– Uses cine loop
– May be ECG gated
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Magnetic resonance angiography (MRA)
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Nuc Med / Pet scanning
Perfusion Scanning
•Myocardial perfusion scan
•Most widely used
procedure
•Gated cardiac blood pool
scans
•Used to evaluate
ventricles
•Positron emission
tomography (PET)
Nuclear cardiology
Used to diagnose CAD,
congenital heart disease, and
cardiomyopathy
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Doppler Ultrasound
•Echocardiography
•M-mode echocardiography
•2-D echocardiography
•Real-time imaging
•Transesophageal
echocardiography (TEE)
•Spectral Doppler
•Color Doppler
•Carotid stenosis, DVT
•Stress echocardiography
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Imaging Considerations
• Computed tomography (CT)
•
•
Cardiac scoring
• EBCT
• Spiral CT
CT angiography (CTA)
Heart CT 3D
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Name of Exam?
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CHECK OUT THE LIVE ACTION!
• http://images.google.com/imgres?imgurl=http://w
ww.heartsite.com/assets/images/cardiac_cath_
man.jpg&imgrefurl=http://www.heartsite.com/htm
l/cardiac_cath.html&h=350&w=269&sz=88&tbni
d=KtrNOVmZWv3nhM:&tbnh=116&tbnw=89&hl=
en&start=57&prev=/images%3Fq%3Dcardiac%2
Bc
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Review of Cardiac Anatomy, Pathology
& Circulation - Lect # 3b